PB2188: PROTON PUMP INHIBITORS ARE SAFE AND EFFECTIVE IN PATIENTS WITH ESSENTIAL THROMBOCYTHEMIA AND POLYCYTHEMIA VERA TREATED WITH LOW-DOSE ASPIRIN
Authors: Ivan Krecak, Ljerka Pivac, Hrvoje Holik, Bozena Coha, Ivan Zekanovic, Martina Morić Perić, Marko Skelin
Journal: HemaSphere (2023)

Topic: 16. Myeloproliferative neoplasms - Clinical Background: Even though proton pump inhibitors (PPIs) significantly decrease the risk of gastrointestinal (GI) bleedings in the general population, these medications also have a pharmacodynamic interaction with aspirin and clopidogrel, potentially decreasing their antiplatelet effect. Patients with essential thrombocythemia (ET) and polycythemia vera (PV) often suffer from peptic ulcer disease and frequently receive low-dose aspirin (75-100 mg) due to intrinsically high thrombotic risk. Aims: To investigate whether PPIs may have an effect on thrombohemorrhagic risk in low-dose aspirin-treated ET and PV patients. Methods: This was a multicenter study conducted at three community hospitals in Croatia. Patients with ET and PV whose disease diagnosis was reassessed according to 2016 World Health Organization criteria were retrospectively included in the period between 2001 and 2022. Clinical and laboratory data was recorded through the medical chart review. Cardiovascular (CV) risk factors of interest were arterial hypertension, active smoking, hyperlipidemia, diabetes mellitus, and chronic kidney disease. Time to thrombosis was measured as the time from diagnosis until the first thrombotic (arterial or venous) event with patients being censored at the time of last follow-up or death, whereas time to bleeding was measured as the time from diagnosis until the first bleeding event. Categorical variables were compared with the chi-square test and continuous variables were analyzed with the Mann-Whitney U test. Survival curves were plotted using the Kaplan-Meier method. Statistics were performed with MedCalc Statistical Software®. Results: A total of 94 low-dose aspirin-treated patients (ET=36, PV=58) were included; median age was 69.5 years (range 21-92), 54 (57.4%) were females, 77 (81.9%) were JAK2 positive, 5 (5.3%) CALR-positive, and 75 (79.8%) received cytoreductive treatment. Nineteen (20.2%) patients were continuously treated with PPIs, mostly due to peptic ulcer disease (n=17, 89.5%), with pantoprazole (n=15, 78.9%) being the most frequent PPI. Male sex (p=0.011) and prior thrombosis (p=0.004) were associated with PPI use, whereas no correlations were found with respect to disease phenotype, age, palpable splenomegaly, mutational status, presence of constitutional symptoms, individual CV risk factors, cytoreductive treatment or blood cell counts (p>0.050 for all analyses). The median follow-up time was 55.5 months; 19 (20.2%) thrombotic (predominantly arterial, n=14/19, 73.6%) and 13 (13.8%) bleeding events (major GI bleedings=8, epistaxis=3, hemoptoa=1, prolonged bleeding after tooth extraction=1) occurred during this time. The use of PPIs was not associated with an increased risk of thrombosis (Figure 1A, p=0.158) or overall bleedings (p=0.229) and none of the patients treated with PPIs experienced GI bleeding events (Figure 1B, p=0.278). Summary/Conclusion: Considering that Helicobacter pylori infection and peptic ulcer disease are frequent in ET and PV patients, our results may provide some reassurance to physicians regarding the safety and efficacy of prolonged PPI use in patients treated with low-dose aspirin. These observations may be even more important in the light of recent evidence suggesting suboptimal platelet inhibition in ET with once-daily low-dose aspirin when compared to more intensive aspirin regimens which may also cause more abdominal discomfort. Limitations of this study are its retrospective design, limited number of patients included, and the lack of pharmacodynamic and pharmacokinetic assessments.Keywords: Thromboembolic events, Bleeding, Platelet, Myeloproliferative disorder